Oncology - Paediatric

Oncology - Paediatric

The treatment of children and young adults with cancer is known as Paediatric Oncology.

What is Paediatric Oncology?

Oncology refers to the branch of medicine that specialises in the study, treatment and management of cancer. A doctor who specialises in oncology is called an oncologist. Paediatric Oncology is the speciality that focuses on cancer in neonates, children, and young adults. A doctor who specialises in paediatric oncology is called a paediatric oncologist.

Narayana Health is a children's cancer hospital that has an expert team with experience in treating the most complex paediatric cancers. There is a difference in the treatment of adult and childhood cancers because the way cancer presents in children is quite different. The reaction of a child’s cancer to the treatment is also different. Most children do not have underlying health issues that adult patients have. Children usually have higher chances of recovery when compared to adults, but they have an added risk of long term side effects from the treatments.

Why NH?

Narayana health hospitals have medical facilities to treat

Tumors that are treated at Narayana Health:

• Wilm's tumor (kidney)
• Hepatoblastoma (liver)
• Neuroblastoma (adrenal)
• Rhabdomyosarcoma (soft tissue tumor)
• Ewing's tumor (PNET)
• Retinoblastoma (eye)

Types of Paediatric Cancer

Cancers in children are of two broad types:

• Hematological or Blood related Cancers
• Solid Tumours - Tumours that arise from other organs

Haematological or Blood-related Cancers

Leukaemia in children is usually of two types:

• Acute lymphoblastic leukaemia (ALL)
• Acute myeloid leukaemia (AML)

Solid Tumours

These are tumours that originate from other organs and parts of the body. They are usually :

• Wilm's tumour

Wilm’s tumours is a kidney cancer and is one of the most common paediatric cancers. When a kidney is being developed in the fetal stage, some of its cells will become glomeruli that perform the filtration function, while others will become nephrons which are the tubes in the kidney. These cells mature at the age of 3 or 4 years of age. If the normal development does not occur these cells become a mass that grows out of control. The mass is always cancerous and is called a Wims tumour or a nephroblastoma. If the early cells of the kidney do not develop into glomeruli of nephrons, clusters of the immature cells may form in the kidneys when the baby is born. Usually, these cells mature by the time a child is 3 or 4 years old, but some may grow out of control, forming a mass of immature cells. This mass is called a Wilms tumour or a nephroblastoma. It is different from kidney cancer that is found in adults because a Wilms tumour can become malignant which means it can spread to other parts of the body. When the tumour is in both the kidneys it is called bilateral, and when it’s in one kidney it is called unilateral. Sometimes it can start in one kidney and then spread to the other.

• Hepatoblastoma

This is the most commonly found type of liver cancer in children and is found in children under the age of three.

• Neuroblastoma

Neuroblastoma is a solid cancerous tumour in children that starts outside the brain, in the nerve cells of infants and young children. Though it is often found to start in the nerve tissue of the adrenal glands it can also start in the chest, neck, pelvis, abdomen, or near the spine.

The adrenal glands are on the top of the kidneys and are the producers of hormones to control functions such as the blood pressure and heart rate. In the fetus, neuroblasts are the immature nerve cells that later mature into either nerve cells or adrenal medulla cells. The adrenal medulla cells are the cells that are found in the adrenal gland. When the neuroblasts do not reach maturity properly they grow into a tumour. This can occur even before birth, and in infants and children under the age of 5.

• Rhabdomyosarcoma

Sarcomas are cancer that develops in the connective tissues of the body. They are also called soft tissue sarcoma or STS. The mesenchymal cells are the cells that develop into the striated or skeletal voluntary muscles. When they do not develop properly they can form tumours called rhabdomyosarcoma. They are most often found in children and young adults, and can occur anywhere in the body.

• Ewing's Tumour or Sarcoma

Ewing sarcoma is a cancer of the bone, or the soft tissue outside the bone. The bone tumours are usually found in the spine, chest, rib, pelvis, arm or leg areas while the soft tissue tumours can be found in the pelvis, thigh, foot, chest wall or spine.

• Retinoblastoma

This is a very rare cancer that is found in the retina, it is usually unilateral or in one eye. When it is in both eyes it is called bilateral. When retinoblastoma cancer spreads it can affect the bones, bone marrow, lymph nodes, and the brain and spinal cord (although it’s quite rare). Though babies can be born with this cancer, it is rarely diagnosed at birth. The chances of cure are higher when cancer has not spread beyond the eye. At Narayana Health the focus is on treating the retinoblastoma while preserving vision.

Diagnosis

The diagnosis of cancer in children is usually performed by a paediatric oncologist. Cancer will be assigned a stage and will be treated according to the stage.

Some of the commonly used diagnostic tests in pediatric oncology are:

• Blood Tests: Some types of cancer are characterised by higher levels of substances called biomarkers or tumour markers in the blood.
• Biopsy: A definitive diagnosis of a cancer is done after studying the suspected tissue. A tissue sample is obtained through a procedure called a biopsy. The sample can be taken through a needle or a surgical incision depending on the type and location of the tumour.
• Bone Scan, Bone Marrow Biopsy or Aspiration: Bone scans are used to detect anomalies in the bones. Bone marrow samples are obtained through bone marrow biopsy or aspiration of further study and diagnosis.
• CT Scan: A computed tomography scan is the diagnostic tool by which two-dimensional images of the internal structure of the body by using X-rays and a contrast dye. There is an exposure to radiation which outweighs the benefits of the scan. For patients who cannot undergo a CT scan, an MRI scan is advisable.
• Magnetic Resonance Imaging (MRI): MRI scans use a strong magnetic field to obtain pictures on the inner structures of the body. They may sometimes use contrast dye for more clarity.
• Positron Emission Tomography (PET): PET scans give more detailed images of the body. PET-CT scans use a combination of PET and CT technology to obtain pictures. PET scans use radioactive material called tracers that are injected into the bloodstream.

Treatment & Preventions

The treatment of childhood cancers is different from that of adult cancer as children react differently to treatments. As child cancers grow quickly, chemotherapy is frequently used in pediatric oncology treatments. Children also recover from high doses of chemo better than adult patients do. Radiation therapy has more serious side effects in children than it does in adults. Since children are in the development stage, the damage that could be caused by radiation to healthy tissue and organs would have more serious long term consequences. Some cancer treatments follow the treatment by chemotherapy with stem cell transplants.

Surgery to remove cancerous tumours is performed to remove all the cancerous cells and a small margin of normal cells around it. Since there is always the chance of having some cells left behind, it is usually followed by chemotherapy.

Paediatric Oncology